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Leading and Managing in Nursing 5th Edition Yoder-Wise Test Bank

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Leading and Managing in Nursing 5th Edition Yoder-Wise Test Bank

ISBN-13: 978-0323069779

ISBN-10: 0323069770

 

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Leading and Managing in Nursing 5th Edition Yoder-Wise Test Bank

ISBN-13: 978-0323069779

ISBN-10: 0323069770

 

 

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Below you will find some free nursing test bank questions from this test bank:

 

Yoder-Wise: Leading and Managing in Nursing, 5th Edition

 

Chapter 14: Staffing and Scheduling

 

Test Bank

 

MULTIPLE CHOICE

 

  1. The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the:
a. Total number of staff on the unit.
b. Staff and RN hours per patient.
c. Total number of staff, and implementing 12-hour shifts.
d. Number of RNs and number of RNs with experience on the unit.

 

ANS:   D

A number of studies (Dunton et al., 2007; Kane, Shamliyan et al., 2007; Ridley, 2008) have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.

 

REF:    Pages 276, 277

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being:
a. 90%.
b. 85%.
c. 75%.
d. 60%.

 

ANS:   B

The occupancy level is calculated as 34/40, or 85%.

 

REF:    Pages 287-289             TOP:    AONE competency: Business Skills

 

  1. To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers:
a. Work time, educational time, and holiday time.
b. Paid hours minus worked hours.
c. Vacation time, holiday time, and sick time.
d. Paid hours minus meeting time.

ANS:   B

Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

 

REF:    Pages 284, 285                        TOP:    AONE competency: Business Skills

 

  1. An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to:
a. Assign staff on the unit on a daily basis.
b. Ensure that days off are planned for the staff.
c. Outline the number of individuals by classification on a per-shift basis.
d. Predict the numbers and classifications of float staff needed to augment regular staff.

 

ANS:   C

A nurse manager needs to manage financial resources by developing staffing plans.

 

REF:    Page 285         TOP:    AONE competency: Business Skills

 

  1. A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external variable to be considered is:
a. Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.

 

ANS:   D

Licensing regulations of the state can determine nurse staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

 

REF:    Pages 278, 279                        TOP:    AONE competency: Business Skills

 

  1. A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is:
a. Organizational staffing policies.
b. State licensing standards.
c. American Nurses’ Association.
d. Consumer expectations.

 

ANS:   A

State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting.

 

REF:    Page 282

TOP:    AONE competency: Knowledge of the Healthcare Environment

 

  1. A nurse manager uses many sources of data when planning the unit’s workload for the year. Which of the following data must be considered in the planning?
a. Hours of operation of the unit
b. Trends in acuity on the unit
c. Maximum work stretch for each employee
d. Weekend requirements

 

ANS:   B

Acuity levels are determined through classification systems, which determine the nursing resources required.

 

REF:    Pages 283, 284

TOP:    AONE competency: Knowledge of the Healthcare Environment

 

  1. Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.

 

ANS:   C

Exact constraints regarding weekends and holidays are determined through contracts and policies.

 

REF:    Page 285         TOP:    AONE competency: Business Skills

 

  1. The difference between staffing and scheduling is that staffing:
a. Puts the right person in the right position.
b. Puts the right person in the right time and place.
c. Refers to the number of nursing hours per patient per day.
d. Looks after interpretation of benefits and compensation.

 

ANS:   A

Staffing is concerned with finding and assigning qualified individuals to care for a group of patients. Scheduling assigns personnel to specific hours and days of the week.

 

REF:    Page 273         TOP:    AONE competency: Business Skills

 

 

  1. A busy neurologic ICU and step-down unit most likely would use which patient classification system?
a. Factor evaluation
b. Prototype evaluation
c. Hybrid system
d. AHRQ system

 

ANS:   A

Complex patient care areas would use a factor evaluation system as compared with a prototype system. AHRQ refers to the Agency for Healthcare Research and Quality, which produces studies related to staffing and scheduling.

 

REF:    Page 275         TOP:    AONE competency: Business Skills

 

  1. In Question 10, the classification system that is used:
a. Utilizes financial data to determine number of staff to patient ratios.
b. Utilizes DRGs to determine acuity on a unit.
c. Combines interventions and time required for interventions to determine levels of care required.
d. Combines financial resources and nursing interventions to determine patient contact hours.

 

ANS:   C

A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required.

 

REF:    Page 275         TOP:    AONE competency: Business Skills

 

  1. Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because acuity is variable.

 

ANS:   B

Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions.

 

REF:    Page 275         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities such as prompted voiding require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of:
a. Bureaucracy.
b. Concern related to the validity of classification systems.
c. Inadequate reliability of classification systems.
d. Inappropriate subjectivity in making judgments about staffing.

 

ANS:   B

Validity of categories and implications for staffing levels are in question in this situation because staffing levels are not reflective of the levels of activity required for patient care.

 

REF:    Page 275         TOP:    AONE competency: Business Skills

 

  1. In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for:
a. Higher patient care hours.
b. Safer facilities.
c. Institution of a patient classification system.
d. An increased number of RN positions.

 

ANS:   D

Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

 

REF:    Page 277         TOP:    AONE competency: Business Skills

 

  1. A strategy to increase RN staff retention at Valley Hospital includes:
a. Better compensation and benefits.
b. Clearer position descriptions.
c. Lay-offs of nursing assistants.
d. Adequate staffing to meet acuity levels.

 

ANS:   D

The ANA surveyed nurses in 2008 and found that 73% believed staffing levels to be inadequate, and 51.9% of those considered leaving their positions (46% cited inadequate staffing as the reason).

 

REF:    Page 277         TOP:    AONE competency: Business Skills

 

  1. In evaluating mortality rates on the weekend, the head nurse on the cardiac unit is surprised to find that it is higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on:
a. Availability of diagnostic personnel.
b. Availability of physicians.
c. Communication with on-call providers.
d. Acuity level of patients.

 

ANS:   C

Studies to date of off-peak hours (weekends and nights) are limited, but those that have been done indicate increased mortality during weekends and nights, when staff work with fewer and often less experienced staff, and when there may be strained communication among on-call healthcare providers.

 

REF:    Page 278

TOP:    AONE competency: Knowledge of the Healthcare Environment

 

  1. A nurse staffing plan takes into account:
a. Specific nurse-to-patient ratios per shift.
b. Participation of nurses in projecting staffing needs.
c. Compensation and benefits for each level of staff.
d. The occupancy load of a unit.

 

ANS:   B

Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse-to-patient ratios.

 

REF:    Page 275         TOP:    AONE competency: Business Skills

 

  1. As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at:
a. Maintaining unit morale.
b. Complying with national requirements.
c. Demonstrating patient outcomes.
d. Inviting staff participation in decision making.

 

ANS:   A

The Joint Commission accreditation reviews staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of the staffing plan is required in some states so that staff may view it. Adequate staffing, as demonstrated through a staffing plan, and compliance reports contribute to staff morale.

 

REF:    Page 275         TOP:    AONE competency: Business Skills

 

  1. To maintain patient safety, studies suggest that scheduling should avoid:
a. Rotating shifts.
b. Weekends.
c. 8-hour shifts.
d. Mandatory overtime.

 

ANS:   A

Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

 

REF:    Page 280         TOP:    AONE competency: Business Skills

 

  1. In a job interview for a staff position, which of the following indicates your knowledge of patient safety?
a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”

 

ANS:   C

Strategies to reduce overtime increase patient safety. Studies suggest that every additional 10% of overtime hours worked contributes to a 1.3% increase in hospital-related mortality.

 

REF:    Page 280

TOP:    AONE competency: Knowledge of the Healthcare Environment

 

  1. To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased acuity levels.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.

 

ANS:   A

A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe.

 

REF:    Page 281

TOP:    AONE competency: Knowledge of the Healthcare Environment

 

  1. To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following?
a. Maximum productive hours
b. Average nonproductive hours
c. Minimum benefit hours
d. Maximum vacation time

 

ANS:   B

To avoid understaffing, average nonproductive or benefit hours need to be taken into account, so the unit is properly staffed when staff members are off.

 

REF:    Pages 288, 289                        TOP:    AONE competency: Business Skills

 

  1. Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to:
a. Seek budgetary approval.
b. Balance personal schedules against institutional needs.
c. Negotiate the schedule with unit staff.
d. Submit the schedule to a centralized staffing office for review.

 

ANS:   D

In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation describes staff self-scheduling models.

 

REF:    Page 286         TOP:    AONE competency: Knowledge of Healthcare Environment

 

MULTIPLE RESPONSE

 

  1. In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager’s role is complex. Which of the following duties are required of a nurse manager (select all that apply)?
a. Responsibility for nursing benchmarks
b. No responsibility for knowledge of staffing benchmarks
c. Responsibility for planning staffing of UNPs only
d. Preparing a unit budget
e. Changing staffing plans based on service needs

 

ANS:   A, D, E

A nurse manager manages financial resources by developing business and staffing plans.

 

REF:    Pages 274-276, 282, 283        TOP:    AONE competency: Business Skills